Does Varicocele Treatment in Adolescence Improve Fertility Outcomes in Adulthood?

Many questions on diagnosis of varicocele in adolescent patients have yet to be adequately answered, particularly regarding paternity outcomes after treated in comparison to conservative monitoring. There have been some promising outcomes after surgical treatment, particularly microsurgical varicocelectomy, but the results are mixed and may not be comparable because of differing variables. Future studies with robust methodologies are needed to identify which adolescents require treatment and when treatment should be initiated to avoid any detrimental effects on future fertility.

Comparing Rates of Polycythemia in Hypogonadal Men Using Nasal Testosterone Gel Versus Intramuscular Testosterone: Update of a Randomized Clinical Trial.

Men with hypogonadism who use intranasal testosterone are less likely to develop polycythemia than men using intramuscular testosterone cypionate.

Medical Treatment of Hypogonadism in Men.

Urologists may commonly diagnose hypogonadism in adult men experiencing an age-related decline in serum testosterone. Low serum testosterone in conjunction with symptoms such as decreased libido, fatigue, memory deficit, or decreased vitality is described as testosterone deficiency syndrome. There are numerous therapeutic options, although each is unique in its formulation, administration, and side-effect profile.

Testosterone replacement therapy and erectile dysfunction.

Testosterone (T) deficiency and erectile dysfunction (ED) are independently functionally and socially impairing, and their concurrence in men can be challenging to treat. Successful management requires an understanding of the mechanisms through which T underlies normal erectile function. While the literature elucidating some of these mechanisms is vast (e.

Management of male sexual dysfunction after cancer treatment.

Background: With an increase in the number of cancer survivors each year, male sexual dysfunction becomes an important topic for discussion between patients and providers who treat cancer. The aim of this article is to review types and mechanisms of sexual dysfunction after cancer therapy and discuss treatment options.

Methods: Contemporary concepts regarding male sexual dysfunction after cancer treatment are reviewed and translated for clinical utility.

Phase II Randomized, Clinical Trial Evaluating 2 Schedules of Low-Intensity Shockwave Therapy for the Treatment of Erectile Dysfunction.

Purpose: To evaluate safety and clinical response of Low-intensity Shockwave Therapy (Li-SWT) for the treatment of erectile dysfunction.

Materials & Methods: A single-institution, 2 arm, phase II randomized clinical trial was conducted between February 2017 and April 2019. Patients were randomized into 2 groups, with Li-SWT delivering a total of 3,600 shocks over 5 days (720 once a day, Group A) or over 2 weeks (600 once a day, 3 times a week, Group B).

Best practices for infection prevention in penile prosthesis surgery.

Purpose Of Review: In this review, we synthesize the most current data on strategies for the prevention and reduction of infections in men undergoing penile prosthesis surgery. We highlight important strategies for preventing infections along every step from patient selection, to the preoperative, intraoperative and postoperative states.

Recent Findings: Over the last decade, significant advances have been made to help minimize penile implant infections, with the most impactful likely being the introduction of antibiotic coated penile implants.

A Novel Video-Based Patient Education Program to Reduce Penile Prosthetic Surgery Cancellations.

Penile prosthetic surgery is an effective treatment for men with erectile dysfunction. Cancellation of surgery is disruptive and costly to patients, physicians, and the healthcare system. This pilot study sought to analyze surgery cancellations and implement a video-based patient education program to decrease surgery noncompletion.

The Basic Physics of Waves, Soundwaves, and Shockwaves for Erectile Dysfunction.

Introduction: Over the past decade, low-intensity extracorporeal shockwave therapy (Li-ESWT) has emerged as a treatment modality for erectile dysfunction (ED). To better appreciate the differences between the various devices for the treatment of ED, it is imperative for physicians to understand the underlying physics of the different shockwave generators.

Aim: In this article, we explain the physics of shockwaves by establishing a foundation regarding the basics of waves, specifically soundwaves.

Update on male reproductive endocrinology.

Practitioners of male reproductive and sexual medicine must have an intimate understanding of the physiology of male reproductive endocrinology, as such a knowledge is the cornerstone on which hormonal treatments are based. In this review, we highlight what is known about male reproductive endocrine physiology and the various control mechanisms for the system. We also discuss the limitations of our current understanding of the reproductive physiology.

Adverse Effects of Cannabis on Male Reproduction.

The use of cannabis use is likely to increase as regulations on its consumption are diminishing throughout the world. Coinciding with an increase in the use of cannabis is an observation that semen quality appears to be declining in developed countries, and couples are delaying conception more often than previous generations. Therefore, it is important to study the effects of cannabis on male reproductive potential in order to better counsel infertile couples and men of reproductive age.

A Phase 2 Randomized Trial To Evaluate Different Dose Regimens of Low-intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction: Clinical Trial Update.

Preliminary results from our study provide further evidence that low-intensity extracorporeal shockwave therapy is a safe and effective treatment modality for erectile dysfunction. Our treatment protocol with shockwaves given to men over 2 wk had the most robust effect.

Whole Exome Sequencing of a Consanguineous Turkish Family Identifies a Mutation in GTF2H3 in Brothers With Spermatogenic Failure.

In this case report we describe our investigation into the genetic cause of infertility due to idiopathic nonobstructive azoospermia in a consanguineous Turkish family. We extracted DNA from blood and applied whole exome sequencing on 4 infertile brothers in this family diagnosed with oligo- and azoospermia. Standard bioinformatics analysis pipelines were run including alignment to the reference genome, variant calling, and quality control filtering.

Policy on Posthumous Sperm Retrieval: Survey of 75 Major Academic Medical Centers.

Objective: To evaluate the presence and content of policies on posthumous sperm retrieval at 75 major academic medical centers in the U.S.

Materials And Methods: We surveyed the top 75 major academic medical centers ranked for research in 2016 by U.

Three-piece Penile Prosthesis Implantation in Refractory Ischemic Priapism-Tips and Tricks.

Introduction And Objectives: Implantation of a penile prosthesis in a patient with significant corporal fibrosis can pose a significant challenge to the surgeon, necessitating the knowledge of specific techniques used to dilate and close aggressively scarred corpora. The objective of our instructional video is to discuss 2 techniques used to approach corporal fibrosis: proper and safe use of cavernotomes for dilation and use of narrower prostheses.

Methods: In this video, we present a 53-year-old man with a history of priapism 3 years ago that lasted 4 days in the setting of trazodone use.

Varicoceles: prevalence and pathogenesis in adult men.

Varicocele, or dilation of the pampiniform venous plexus, affects up to 15% of men. However, few of these men encounter problems with fertility. This discrepancy between men with varicocele and the number of adversely affected men has led to abundant research to identify the mechanisms for formation of varicocele as well as the pathologic mechanisms by which varicoceles affect fertility potential.

Transurethral resection of ejaculatory ducts: a step-by-step guide.

Objective: To demonstrate the key components for completing a successful transurethral resection of ejaculatory ducts (TURED) for completely obstructed ejaculatory ducts (EDs).

Design: Video presentation.

Setting: University Hospital.

Microsurgical identification and excision of an intratesticular mass.

Objective: To demonstrate a step-by-step approach to microsurgical partial orchiectomy (PO) in a man with a small intratesticular mass.

Design: Video presentation.

Setting: University hospital.